A pilot study of longitudinal changes in neurocognition, white matter hyperintensities, and cortical thickness in atrial fibrillation patients following catheter ablation vs medical management

BackgroundCerebral microembolization and atrophy complicate atrial fibrillation (AF).ObjectivesWe aimed to compare changes in neuroimaging findings between AF patients treated with catheter ablation and those treated with medical therapy.MethodsIn this pilot study, we evaluated differences in the change in regional white matter hyperintensity burden (WMHb) and cognitive function from baseline to 6-weeks and 1-year in patients treated with AF ablation (ABL, n=12) and patients treated with medical management alone (MM, n=11). Change in cortical thickness in Alzheimer’s Disease (AD)-risk, aging-associated or shared AD-risk/aging regions was also compared between groups.ResultsThe mean age was 69.7±5.0, 78% of patients were male, 39% had persistent AF, and all received oral anticoagulation. There were no significant differences between groups in the change in cognitive function. At 6-weeks, there were no significant differences in periventricular WMHb changes between groups (0.00 vs. 0.04; p=0.12), but changes in attention/concentration were inversely correlated with periventricular (p=0.01) and total WMHb (p=0.03). MM patients demonstrated significantly greater cortical thinning in AD-risk regions from baseline to 1-year (p=0.003).ConclusionsAF patients who underwent ablation demonstrated less cortical thinning in regions associated with AD risk than patients treated with medical therapy. Larger, prospective studies are needed to better understand the relationship between AF therapies and the development of cognitive decline.